Tuesday, June 6, 2017

Radiologists have an identity crisis

Here's a question that has been debated for several years: Should radiologists talk to patients about their imaging results? Citing several issues, I came down solidly on the "No" side in a 2014 blog post which you can read here.

Two major radiology organizations have committees looking into the concept, and a New York Times article said, "they hope to make their case [for it] by demonstrating how some radiologists have successfully managed to communicate with patients and by letting radiologists know this is something patients want."

However, a recent paper presented at the annual meeting of the American College of Radiology raised a new issue.

Apparently patients need more basic information before talking to radiologists—namely what exactly is a radiologist and what does a radiologist do?

A group from the University of Virginia surveyed patients waiting to have radiologic studies performed and came up with some remarkable results. Of 477 patients surveyed, only 175 (36.7%) knew that a radiologist is a doctor, and 248 (52%) knew that radiologists interpret images.

Based on those findings, the investigators developed an educational program of PowerPoint slides which was shown to a new series of 333 patients in the waiting room. When surveyed after viewing it, 156 patients (47.7%) said they were aware that a radiologist is a doctor, and 206 (62.2%) knew that radiologists interpret images.

Both responses were significantly better after the educational presentation, but still, less than 50% of patients identified radiologists as doctors. Maybe the problem was the PowerPoint. Maybe radiologists need to wear scrubs or drape stethoscopes around their necks.

This is only a small study from one institution. Nevertheless before taking the big step of talking with patients, it suggests radiologists need to do a better job of explaining who they are and what they do.

We surgeons think we have an image problem when people say to us, "Oh, are you just a general surgeon?" They don’t know what we do, but at least they know we are physicians.

19 comments:

artiger said...

This is only anecdotal, but no self-respecting radiologist whom I know would want to talk to a patient. That's why they chose their field.

More seriously, I have a hard time believing the majority of the members of those two societies support this. If any of our radiology colleagues out there know otherwise, I certainly stand corrected.

If this were to go through, I guess the pathologists would want to be next. Of course, I seriously doubt any of this happens without an increase in reimbursement...right.

Phil said...

As a radiology resident, my ego isn't really hurt that much by Joe Six-Pack not knowing I'm a physician or that I'm the one who diagnosed his HCC (too many six packs, it seems) on that CT scan, not his primary physician. The issue we have is that the patient not knowing or caring who we are makes it easier for others in the healthcare industry to turn radiology into a commodity (something we're partially to blame for by hermiting in the reading room for the last couple decades, not to be seen or heard from beyond a written report). If the patients don't know or care who interprets their CT scan, why not save 25% by going with this teleradiology group? The patients don't know the difference, and these easy to measure turn-around times are excellent for this cheaper group!

These issues are not entirely unique to radiologists (how many patients know who interpreted their biopsy results, or know that the way you take extra time and care to do their closure with sutures instead of staples will give them a better cosmetic result while most other surgeons would have used staples to get out of there faster?), but it is certainly magnified by the nature of our work. The ineffectiveness of the presentation is disheartening just because it further shows that keeping radiology from becoming commoditized won't be simple. It will happen to more specialities with the financial crunch on healthcare and administrators look to save that money by finding cheaper physicians, but it will hit radiologists sooner than others if we don't find a good way to demonstrate the value of what we do to patients and to others in healthcare.

Robert Ley said...

This seems to be much ado about nothing. Finding "cheaper physicians"? How about no physician at all? Non-interventional radiologists, like pathologists and dermatologists, will, in the very near future, be superfluous.
http://www.newyorker.com/magazine/2017/04/03/ai-versus-md
When unemployment hits the professions, as it will, stuff will hit the fan big time. Be prepared!

Skeptical Scalpel said...

Great comments all. Good points about pathologists being next and cheaper physician vs. no physicians at all.

Will Ogilvie said...

In formed consent for diagnostic procedures is important. Interpreting the clinical implications of those results is beyond the scope of the radiology specialty. Prudent readiologists say "Clinical correlation suggested."

Skeptical Scalpel said...

Will, I agree. As I said in my previous post about this, the first question after the patient finds out what the study shows is "What needs to be done?'

Anonymous said...

Our 250 bed hospital administration have just announced plans to "outsource" our radiologists. Just IR and breast stuff will be done by a real live radiologist. From my experience the telerad service is poor quality and, unfortunately, no one in administration cares.

Todd J. Scarbrough, M.D. said...

I don't know what the "policy" is per se, but many of the breast CA patients I see say they discussed their results with the MD mammographer at some point in time. This is pretty much the only instance in the world of radiology that I hear patients speaking of having talked with the radiologist, however. But the question arises: why is that the only instance. CYA? Liability concerns?

Skeptical Scalpel said...

Anon, I agree that some teleradiology services are not good. Also, it can be difficult to discuss a case with them at night.

Todd, you make a good point that many mammographers do speak to patients. As to why that is the only instance of them doing so, I do not know.

Anonymous said...

Yes, taking a picture gives one instant patient-doctor relationshipand any radiologist can, after looking at a mammogram or MRI just know enough about the patient, their life, family, and health status that giving them a diagnosis of breast cancer or lung cancer is no problem. We should all just hold the patients and then go out there with a smiley face on for those with a negative exam (90%) and then have a private room for those with a potential death sentence to be delivered by a person they have never met before. Brilliant.

Skeptical Scalpel said...

Anon, well said.

Karl Chiang said...

As an Interventional Radiologist, I am actively involved with patients before and after a procedure. Interventional Radiology is now a "new residency" which separate board from Diagnostic Radiology. We are more like surgeons than Radiologists(most prefer to be in the dark). The exception besides IR is Mammography. Our Mammographers are actively involved with patients especially with stero biopsies etc.

Skeptical Scalpel said...

Karl, I agree. As noted above, many mammographers do interact with patients. IR is like surgery in that you must explain what you are going to do to the patient and get consent and it would be bad form not to speak to the patient and/or family afterward.

Michael Kelley said...

There are three areas of subspecialty Radiology in which many of my partners have routinely shared with our patients the findings and results of their exams. These include mammography (results of biopsies called directly to the patient by our mammographers); IR results of procedures and treatments with planned follow up following UAE, chemoembolization, Fallopian tuboplasty, etc.; and fluoroscopic procedures such as Barium GI studies, post op cystograms, water-soluble contrast ememas, and hysterosalpingograms.
Our communication with these patients may be included in our report. After years of communicating with these patients, I have never heard a negative comment from their referring physician. These patients leave our Department with useful information that they can discuss with their physician, and they depart knowing that they have spoken to an MD RADIOLOGIST!

Skeptical Scalpel said...

Michael, that is remarkable. Two questions. Why is it that your group can do it yet many others feel it can't be done? Why can't you tell patients about their CT scans, MRIs and ultrasounds?

Michael Kelley said...

We are currently exploring avenues to make imaging reports available to patients. Since these cases, unlike the procedures/results that we currently discuss with patients, are usually dictated apart from the patient, we will have to develop a "hot line" where patients can contact an appropriately trained radiologist, to ask questions about their results.This would not necessarily need to be the dictating radiologist.

Those cases with "bad news" (new tumor in the lung on CT, worsening PET findings, etc.) would not lend themselves to such a reporting system and would be off limits. The primary downside to this hot line system would be the extra manpower and support required to accomplish it.

Skeptical Scalpel said...

Michael, thanks for the info.It sounds like you are in a progressive group. It will be interesting to see if you can solve the problem you raised in your last sentence.

artiger said...

I'm all for making progress and not just doing things "the way we've always done it", but unless extra reimbursement is offered, I can't see this becoming a widespread practice. And I can't see extra reimbursement coming, at least not in my lifetime.

Skeptical Scalpel said...

I agree. I doubt there will be any compensation for a radiologist talking to a patient. They might be able to bill it under one of the existing codes but I think it would be challenged. Duplication of services if the PCP or consultant does the same thing.

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